<!DOCTYPE html>
<html>
<meta charset="utf-8">
<head th:include="include :: header"></head>
<body class="gray-bg">
<div class="wrapper wrapper-content ">
    <div class="row">
        <div class="col-sm-12">
            <div class="ibox float-e-margins">
                <div class="ibox-content">
                    <form class="form-horizontal m-t" id="signupForm">
                        <input id="id" name="id" th:value="${hospital.id}" type="hidden">
                        <input id="version" name="version" th:value="${hospital.version}" type="hidden">

                        <div class="form-group">
                            <label class="col-sm-3 control-label">名称：</label>
                            <div class="col-sm-8">
                                <input id="name" name="name" th:value="${hospital.name}" class="form-control"
                                       type="text">
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-3 control-label">英文名称：</label>
                            <div class="col-sm-8">
                                <input id="englishName" name="englishName" th:value="${hospital.englishName}"
                                       class="form-control" type="text">
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-3 control-label">所在地区：</label>
                            <div class="col-sm-8">
                                <input id="region" name="region" th:value="${hospital.region}" class="form-control"
                                       type="text">
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-3 control-label">地址：</label>
                            <div class="col-sm-8">
                                <input id="address" name="address" th:value="${hospital.address}" class="form-control"
                                       type="text">
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-3 control-label">NICU级别：</label>
                            <div class="col-sm-8">
                                <input id="nicu" name="nicu" th:value="${hospital.nicu}" class="form-control"
                                       type="text">
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-3 control-label">介绍：</label>
                            <div class="col-sm-8">
                                <input id="intro" name="intro" th:value="${hospital.intro}" class="form-control"
                                       type="text">
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-3 control-label">顺产价格：</label>
                            <div class="col-sm-8">
                                <input id="naturalChildbirthPrice" name="naturalChildbirthPrice"
                                       th:value="${hospital.naturalChildbirthPrice}" class="form-control" type="text">
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-3 control-label">剖腹产价格：</label>
                            <div class="col-sm-8">
                                <input id="caesareanSectionPrice" name="caesareanSectionPrice"
                                       th:value="${hospital.caesareanSectionPrice}" class="form-control" type="text">
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-3 control-label">其他费用：</label>
                            <div class="col-sm-8">
                                <input id="otherFee" name="otherFee" th:value="${hospital.otherFee}"
                                       class="form-control" type="text">
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-3 control-label">合作医生：</label>
                            <div class="col-sm-8">
                                <input id="doctors" name="doctors" th:value="${hospital.doctors}" class="form-control"
                                       type="text">
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-3 control-label">：</label>
                            <div class="col-sm-8">
                                <input id="remark" name="remark" th:value="${hospital.remark}" class="form-control"
                                       type="text">
                            </div>
                        </div>
                        <div class="form-group">
                            <div class="col-sm-8 col-sm-offset-3">
                                <button type="submit" class="btn btn-primary">提交</button>
                            </div>
                        </div>
                    </form>
                </div>
            </div>
        </div>
    </div>
</div>
<div th:include="include::footer"></div>
<script type="text/javascript" src="/js/appjs/usabb/hospital/edit.js">
</script>
</body>
</html>
